Name of Manual - Blue Cross and Blue Shield of Minnesota

Provider Agreements
Responsibilities of
Participating Providers
(continued)
Requirements of
Minnesota Law
• Promptly furnishing at the provider’s own expense any
additional information that Blue Cross or the plan sponsor shall
reasonably request as necessary to respond to claims,
utilization review, coordination of benefits, quality
improvement and care management reviews, pre-certification
reviews, preadmission notification, prior authorization, medical
necessity reviews, credentialing, and medical abstract reports.
The provider shall be responsible for obtaining any
authorization required to release such information to Blue
Cross or the plan sponsor.
• Provider will collect appropriate copayment amounts and not
waive these amounts.
• Billing the patient for noncovered services listed as exclusions
in the patient’s coverage certificate.
• Participating providers may not collect any difference between
the amount billed and Blue Cross’ allowance for health
services.
• Charging members of the general public the same amounts as
Blue Cross members (individual hardship cases are an
exception).
• Billing only for services personally performed by your medical
staff or other professionals employed by your facility that meet
the eligibility criteria defined by Blue Cross.
Minnesota law requires participating providers to look to Blue
Cross for payment of services covered by the member’s contract.
Following are requirements:
• Providers may not bill patients for services covered by their
Blue Cross health plan only in accordance with Minnesota law
for the applicable coinsurance, copayment or deductible and
providers may not withhold treatment in the event that a patient
is unable to make payment in advance and prior to Blue Cross
completing processing of the claim or adjustment.
• Providers may not refer a patient’s account to collection for
nonpayment of services covered by the Blue Cross health plan.
Copayments, coinsurance and deductibles can be coordinated
through the clinic’s normal billing, and if applicable, their
collections process.
• Interest on services covered by Blue Cross may not be applied
to a patient’s account.
2-4 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (01/05/10)